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General NPI Number Information
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NPI Number | 1649090150
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Entity Type | Organization
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Legal Business Name | WHITE MEMORIAL COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1701 E CESAR E CHAVEZ AVE STE 456
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City | LOS ANGELES
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State | CA
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Zip | 90033-2496
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Country | US
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Telephone | 323-987-1200
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Fax | 323-987-1212
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Provider Business Mailing Address
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Address Line | 1828 E CESAR E CHAVEZ AVE STE 6100
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City | LOS ANGELES
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State | CA
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Zip | 90033-2597
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Country | US
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Telephone | 323-859-3627
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Fax | 323-987-1212
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Authorized Official
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Title or Position | CEO-CMO
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Name | GRACE FLOUTSIS
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Credential |
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Telephone | 323-987-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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